Renal Failure After Cardiac Surgery

Acute kidney injury (AKI) is the most common clinically important complication after cardiac surgery. In critically ill patients, cardiac surgery is the second most common cause of AKI after sepsis. The development of acute kidney injury is independently associated with significant short- and long-term morbidity and mortality. In this chapter, we explore the definition of cardiac surgery associated acute kidney injury (CSA-AKI), and identify its risk factors. We discuss current theories of the pathophysiology of CSA-AKI and describe its clinical course. Furthermore, we introduce diagnostic tools with particular reference to novel biomarkers of AKI and their potential utility. We also analyze currently applied interventions aimed at attenuating AKI in patients undergoing cardiac surgery. Finally, we explore issues in the use of renal replacement therapy, its timing and its preferred modalities in patients with CSA-AKI, and discuss the prognosis of CSA-AKI in terms of patient survival and kidney recovery.